<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700095
Report Date: 04/14/2022
Date Signed: 04/14/2022 10:22:46 AM


Document Has Been Signed on 04/14/2022 10:22 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:SAINT JOHN THE EVANGELIST PRESCHOOLFACILITY NUMBER:
376700095
ADMINISTRATOR:JILL BURKEFACILITY TYPE:
850
ADDRESS:1003 ENCINITAS BOULEVARDTELEPHONE:
(760) 944-8227
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:89CENSUS: 62DATE:
04/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Director Jill Burke and Assistant Director Faedene BarnesTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/14/2022 @ 9:40 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 4/5/22 wherein a 5 year old child (Child #1) jumped off a play structure, landing and sustaining a hairline fracture to the wrist.

LPA spoke with Child #1 and examined the play structure and area where the child fell. It is age appropriate for 5 and up and the rubber chip cushioning beneath is sufficient and in good repair. Child #1 had been moving along the monkey bars and had been successful a couple times already. However, the next time around Child #1 lost grip and fell to the rubber chips underneath. The monkey bars are approximately 6-7 feet high and the child is approximately 4 feet tall. Child #1 stated that hands were out to brace the fall upon landing. Child #1 said that the teacher was standing by the swings and didn't see the fall. Child #1 walked to the teacher to tell her and she got an ice pack to apply. Child #1 did not say that it was a jump but Assistant Director Faedene Barnes stated that Child #1 described it to her, it was described as "letting go" or "jumping" off. LPA noted that the swings are approximately 20 ft from the play structure. Child #1 confirmed that there were no other children who bumped, pushed or were in the way, causing the slip.

There were 10 children on the playground at the time of the incident with one teacher (Staff #1). Staff #1 was not present today, however, a written statement had been received prior, detailing the incident. Supervision, while not direct to the play structure, was in place and the ratios were met. Although this appears to be accidental as described by Child #1, additional supervision near play structures is recommended. Director stated that there are two groups with two teachers, however at that time the other teacher had taken a child to the restroom.

No deficiencies are cited at this time.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1